| NPI | 1629312368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY6946) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: ID PSY202445) |
| Enumeration Date | 2012-11-19 |
| Last Update Date | 2015-12-17 |